人附睾蛋白4对慢性肾脏疾病的诊断价值研究

doi:10.3969/j.issn.1673-8640.2015.05.013

摘要/Abstract

摘要： 目的检测人附睾蛋白4(HE4)在慢性肾脏疾病(CKD)中的表达水平,评价HE4对CKD的诊断价值。方法用电化学发光法测定81例CKD患者和73名健康对照者(正常对照组)血清HE4、糖类抗原(CA)125、甲胎蛋白(AFP)、癌胚抗原(CEA)、CA199、CA15-3等指标,采用受试者工作特征(ROC)曲线分析各指标对CKD各分期的诊断价值。结果 CKD组血清HE4、CA125、CEA、CA15-3、尿素、肌酐和尿酸水平均明显高于正常对照组(P<0.05),而血清AFP、CA199水平2组之间差异无统计学意义(P>0.05)。ROC曲线分析显示HE4对CKD的诊断性能最佳,其曲线下面积均大于血清肌酐、尿素和尿酸。CKD不同分期患者之间血清HE4、CEA、尿素、肌酐和尿酸水平差异均有统计学意义(P均<0.005),且随病情严重程度的增加而增高。ROC曲线分析显示血清HE4、尿素、肌酐和尿酸水平对4~5期CKD均具有明显的诊断意义,曲线下面积均>0.9。结论 HE4 对CKD具有极好的辅助诊断价值,且HE4值还与CKD的严重程度有关,对判断CKD的分期有重要的临床意义。

关键词: 人附睾蛋白4, 糖类抗原125, 肾小球滤过率, 肌酐, 尿素, 肿瘤标志物, 慢性肾脏疾病

Abstract: Objective To determine the level of human epididymis protein 4(HE4), and to evaluate its diagnosis significance for chronic kidney disease(CKD). Methods A total of 81 CKD patients and 73 healthy controls were enrolled. The determinations of serum HE4, carbohydrate antigen(CA)125, alpha fetoprotein(AFP), carcinoembryonic antigen(CEA), CA199, CA15-3 and so on were performed by electrochemiluminescence. The results were analyzed by receiver operating characteristic(ROC) curve for the diagnosis of CKD with different stages. Results The levels of serum HE4, CA125, CEA, CA15-3, urea, creatinine and uric acid were significantly higher in CKD patients than those in healthy controls(P<0.05), while there was no statistical significance for AFP and CA199 between the 2 groups (P>0.05). ROC curve analysis indicated that compared with other parameters, HE4 had a better diagnosis significance for CKD. The area under the curve of HE4 was larger than those of urea, creatinine and uric acid. Additionally, there were statistical significances for serum levels of HE4, CEA, urea, creatinine and uric acid among various stages of CKD(P<0.005). Moreover, the serum levels of these parameters increased with severity of CKD. ROC curve analysis showed that serum HE4, urea, creatinine and uric acid had significant diagnosis significance for staging CKD(CKD4-5), with the area under the curve>0.9. Conclusions Serum HE4 shows an excellent diagnosis significance for CKD. Furthermore, it is closely associated with the severity of CKD. It is significant for judging the stages of CKD.

Key words: Human epididymis protein 4, Carbohydrate antigen 125, Glomerular filtration rate, Creatinine, Urea, Tumor marker, Chronic kidney disease

中图分类号:

R446.62

吴萍, 叶伟民, 李晨, 夏晓红, 张振成, 赵文静, 崔艳芳, 张彩英, 仲人前, 杨再兴. 人附睾蛋白4对慢性肾脏疾病的诊断价值研究[J]. 检验医学, 2015, 30(5): 461-464.

WU Ping, YE Weimin, LI Chen, XIA Xiaohong, ZHANG Zhencheng, ZHAO Wenjing, CUI Yanfang, ZHANG Caiying, ZHONG Renqian, YANG Zaixing. Research on the diagnosis significance of human epididymis protein 4 for chronic kidney disease[J]. Laboratory Medicine, 2015, 30(5): 461-464.

图/表 6

参考文献 11

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组别	例数	HE4(pmol/L)	CA125(U/mL)	CEA(μg/L)		CA15-3(U/mL)
CKD组	81	287.2(46.5~1 231.0)	14.68(4.13~549.00)	2.19(0.20~20.10)		9.80(3.92~56.16)
正常对照组	73	43.5(18.2~88.7)	11.90(1.92~80.13)	1.10(0.20~7.13)		8.90(4.20~34.59)
P值		<0.001	0.002	<0.001		0.029
组别	例数	尿素(mmol/L)	肌酐(μmol/L)	尿酸(μmol/L)	AFP(μg/L)	CA199(U/mL)
CKD组	81	12.9(3.0~52.0)	271(45~1 892)	451(137~932)	1.90(0.51~42.37)	8.46(0.50~80.20)
正常对照组	73	5.0(2.8~9.2)	56(39~90)	254(111~576)	1.87(0.51~6.32)	9.12(0.60~34.78)
P值		<0.001	<0.001	<0.001	0.354	0.537

组别	例数	HE4(pmol/L)	CA125(U/mL)	CEA(μg/L)		CA15-3(U/mL)
CKD组	81	287.2(46.5~1 231.0)	14.68(4.13~549.00)	2.19(0.20~20.10)		9.80(3.92~56.16)
正常对照组	73	43.5(18.2~88.7)	11.90(1.92~80.13)	1.10(0.20~7.13)		8.90(4.20~34.59)
P值		<0.001	0.002	<0.001		0.029
组别	例数	尿素(mmol/L)	肌酐(μmol/L)	尿酸(μmol/L)	AFP(μg/L)	CA199(U/mL)
CKD组	81	12.9(3.0~52.0)	271(45~1 892)	451(137~932)	1.90(0.51~42.37)	8.46(0.50~80.20)
正常对照组	73	5.0(2.8~9.2)	56(39~90)	254(111~576)	1.87(0.51~6.32)	9.12(0.60~34.78)
P值		<0.001	<0.001	<0.001	0.354	0.537

指标	曲线下面积	95%可信区间	P值
HE4	0.978	0.960~0.996	<0.001
尿素	0.875	0.819~0.930	<0.001
肌酐	0.956	0.922~0.990	<0.001
尿酸	0.832	0.762~0.901	<0.001

指标	曲线下面积	95%可信区间	P值
HE4	0.978	0.960~0.996	<0.001
尿素	0.875	0.819~0.930	<0.001
肌酐	0.956	0.922~0.990	<0.001
尿酸	0.832	0.762~0.901	<0.001

分期	例数	HE4(pmol/L)	CA125(U/mL)	CEA(μg/L)	CA15-3(U/mL)	尿素(mmol/L)	肌酐(μmol/L)	尿酸(μmol/L)
CKD1	28	87.6 (52.1~252.0)	19.00 (9.00~549.00)	1.98 (0.20~5.91)	13.09 (6.93~23.88)	3.9 (3.0~6.4)	76 (46~153)	361 (141~413)
CKD2	22	94.9 (46.5~633.0)	16.78 (6.62~398.20)	1.87 (0.67~5.17)	9.64 (3.92~56.16)	6.4 (3.9~30.6)	92 (45~124)	431 (167~587)
CKD3	5	252.3 (119.0~417.2)	15.24 (4.13~220.70)	2.72 (0.69~4.17)	11.08 (5.96~33.51)	9.1 (2.9~16.1)	135 (119~401)	413 (137~671)
CKD4	8	781.3 (199.6~976.0)	21.35 (8.15~93.28)	3.41 (0.49~7.58)	8.49 (6.01~36.16)	17.2 (12.5~44.2)	439 (153~1 892)	545 (321~671)
CKD5	18	899.2 (553.8~1 231.0)	12.60 (4.98~98.24)	5.29 (1.13~20.10)	12.96 (11.92~35.71)	28.9 (6.2~52.0)	701 (330~1 315)	631 (237~932)
P值		<0.001	0.336	0.001	0.871	<0.001	<0.001	0.001